ANATOMY TEAM VASCULAR ANATOMY OF THE UPPER LIMB Vascular anatomy of the upper limb Lec. (11)"BOYS" Lec. (13) "GIRLS" Objectives: At the end of the lecture, the students should be able to: • Identify the origin of the vascular supply for the upper limb. • Describe the main arteries and their branches of the arm, forearm & hand. • Describe the vascular arches for the hand. • Describe the superficial and deep veins of the upper limb. تنويه / هذا العمل ﻻ يعتبر مصدر أساسي للمذاكره وإنما هو للمراجعه فقط والمصدر اﻻساسي هو السﻻيدز ، وقد تم التأكد بأنه ﻻ يوجد أي اختﻻف بين سﻻيدز اﻷوﻻد والبنات "ماعدا اختﻻف بسيط في سﻻيد 11 عند اﻷوﻻد" . Muscular. Nutrient to humerus. Profunda brachii . Superior ulnar collateral. Inferior ulnar collateral. Terminal; radial and ulnar The Subclavian Artery The right artery originates from the brachiocephalic artery. The left artery originates from the arch of the aorta The Subclavian Artery is Cotinues as Axillary artery at the lateral border of the 1st rib 1st part of the axillary artery: Begins at the - Extends from the lateral border of 1st rib lateral border of to upper border of the pectoralis minor the 1st rib as muscle. continuation of . Related: the subclavian • Anterioly: to the pectoralis artery. major muscle • Laterally: to the cords of the brachial plexus. Continues as • ONE branch: Highest thoracic brachial artery at artery. lower border of teres major 2nd part of the axillary artery: muscle. Lies behind the pectoralis minor muscle. It is related medially, laterally, and Is closely related posterioly to the corresponding cord of to the cords of the brachial plexus. TWO branches: brachial plexus • Thoracoacromial a. and their • Lateral thoracic a. branches. 3rd part of the axillary artery: Is enclosed within • Extends from the lower border of the axillary pectoralis minor muscle to the lower border teres major muscle. sheath. • Related medially, laterally, and Is crossed posterioly, to the branches of the cords of the brachial plexus anteriorly by the pectoralis minor • Gives THREE Branches: muscle, and is • Subscabular, • Anterior circumflex humeral divided into three • Posterior circumflex humeral. parts; 1st, 2nd & 3rd. st 1 part 2nd part rd Highest thoracic 3 part artery a. Pec. minor Thoraco - acromial a. Lateral Teres major Thoracic a. Subscapular Anterior & posterior a. circumflex humeral aa. rd For 3 part For 2nd part st For 1 part Is a continuation of the The Ulnar Artery : axillary artery at the lower border of teres major muscle. The larger of the two terminal branches of the brachial artery. Provides main arterial supply for the arm. Begins in the cubital fossa at the level of neck of radius. Terminates opposite neck of radius by dividing into radial . Descends through the anterior & ulnar arteries. compartment of the forearm. Enters the palm, in front of the flexor Relations: retinaculum, with the ulnar nerve. Anteriorly: crossed from . Ends by forming the superficial palmer above downward by medial arch, by anastomosing with superficial cutanous nerve of the palmer branch of radial artery. forearm, median nerve, and bicipital aponeurosis. Branches: - Muscular . Posterioly: triceps, coraco- - Recurrent branch for anastomosis brachialis and brachialis. around the elbow joint. - Common interosseous artery, which Medially: basilic vien, ulnar gives anterior and posterior and mdian nerves. interosseous arteries. Laterally: coracbrachialis and - Branch to anastomoses around the biceps muscles. wrist joint. Branches: The Radial Artery: - Muscular. - Nutrient to humerus. The smaller of the two terminal - Profunda brachii branches of the brachial artery. - Superior ulnar collateral. - Inferior ulnar collateral. Begins in the cubital fossa at the level of - Terminal; radial and ulnar neck of radius. Descends downward and laterally. Leaves the forearm by winding around the lateral aspect of the wrist to reach the dorsum of the hand. Branches: - Muscular - Recurrent branch for anastomosis around the elbow joint. - Superficial palmar branch , joins the ulnar -artery to form the superficial palmar arch. Brachial artery ulnar artery radial artery NOTE: if you want to see the Relations & Branches go back to the slide Arteries of the Palm Ulnar artery: Radial artery: Enters the hand: . Leaves dorsum of the hand by turning forward between the proximal ends of - anterior to the flexor the 1st and 2nd metacarpal bones and retinaculum, two heads of the 1st dorsal inerossous - on the lateral side of the muscle. ulnar nerve and pisiform . On entering the palm it continues as bone. deep palmar arch. Gives a deep branch. It gives; arteria radialis indecis and Continue as the superficial palmar arteria princeps policis. arch. Ulnar artery Radial artery st 1 dorsal interosseous muscle - Is the direct continuation of the ulnar - Is a continuation of the radial artery as artery, as it curves laterally behind the - it curves medially beneath long flexor palmar aponeurosis. tendons , in front of the metacarpal - Is completed by branch from the bones and interosseous muscles. radial artery. - Is completed on the medial side by - Lies approximately at the level of the deep branch of ulnar artery. distal border of the extended thumb. - Lies at a level of the proximal border - Gives: digital arteries from its of extended thumb. convexity to supply the fingers. It sends branches: Radialis superiorly to share in indices a. anastomosis around the Princeps pollicis a. wrist joint & inferiorly to join branches of the superficial palmar arch. Digital arteries Radial a. Ulnar a. Deep Palmar Arch • The veins of the upper limb are divided into two sets: Superficial and Deep. • The two sets anastomose frequently with each other. • The superficial veins are placed immediately beneath the skin, in the superficial fascia. • The deep veins accompany the arteries, and constitute the venæ comitantes of those vessels. Cephalic Vein : . The dorsal digital - Arises from the lateral end of the dorsal veins drain into dorsal venous arch of hand. metacarpal veins, which - Ascends on radial side of the forearm to the unite to form a dorsal venous arch or network. elbow and continues up the arm in the deltopectoral groove. Dorsal venous network lies clavipectoral fascia to drain )يثقب) Pierces - on the dorsum of the hand, into the axillary vein. in the subcutanous tissue, proximal to the Basilic Vein : metacarpophalangeal joints - Arises from the medial side of the dorsal . Drains into the cephalic venous arch of hand. vein laterally, and basilic - Ascends on the ulnar side of forearm to the vein medially. elbow , in the middle of the arm, it pierces the deep fascia and joins the brachial vein and ends as axillary vein. Median Cubital Vein: - Links cephalic vein and basilic vein in the cubital fossa. - Is a frequent site for venipuncture. See : very useful picture http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels_files/ima ge040.jpg Deep Veins of the Upper Limb . Accompany the arteries of the same region and bear similar names. Venae commitantes: They are generally arranged in pairs, and are situated one on either side of the corresponding artery, and connected at intervals by short transverse branches. The superficial and deep palmar arterial arches are each accompanied by a pair of venæ comitantes which constitute the superficial and deep palmar venous arches, and receive the veins corresponding to the branches of the arterial arches. The deep veins of the forearm are the venæ comitantes of the radial and ulnar veins . The brachial veins are placed one on either side of the brachial artery. The axillary vein: The subclavian vein: . Begins at the lower border . Is the continuation of the axillary of the Teres major, as the vein. continuation of the basilic . Extends from the outer border of vein. the first rib to the sternal end of . Ends at the outer border of the clavicle, where it unites with the internal jugular to form the the first rib as the brachiocephalic (innominate) subclavian vein. vein. Receives the brachial veins and, close to its termination, the cephalic vein. Some important notes: The Subclavian Artery is Cotinues as Axillary artery. The Axillary Artery Continues as brachial artery. Axillary Artery divided into three parts; 1st, 2nd & 3rd. 1st parts of Axillary Artery have one branch. 2nd parts of Axillary Artery have two branches. 3rd parts of Axillary Artery have three branches. The Ulnar Artery is larger than Radial Artery. Radial artery Leaves dorsum of the hand by turning forward between the proximal ends of the 1st and 2nd metacarpal bones. The Superficial Palmar Arch Is the direct continuation of the ulnar artery. The Deep Palmar Arch Is a continuation of the radial artery. The superficial palmar arch is more distal than the deep palmar arch. The veins of the upper limb are divided into two sets: Superficial and Deep. The dorsal digital veins drain into dorsal metacarpal veins, which unite to form a dorsal venous arch or network. Cephalic Vein Arises from the lateral end & Ascends on radial side. Basilic Vein Arises from the medial side & Ascends on the ulnar side. Median Cubital Vein Links cephalic vein and basilic vein The axillary vein receives the brachial veins & close to its termination the cephalic vein & Ends as the subclavian vein. Review 1- The Subclavian Artery Continues as? Axillary artery. 2- The Axillary Artery Begins at the? Lateral border of the 1st rib. 3- The Axillary Artery Is enclosed within the? Axillary sheath. 4- The 1st part of the axillary artery Extends from the? Lateral border of 1st rib. 5- The 1st part of the axillary artery Related Anteriorly to the? pectoralis major muscle. 6- The Brachial Artery Is a continuation of the? axillary artery. 7- The Brachial Artery Terminates opposite neck of radius by dividing into? radial & ulnar arteries. 8- Brachial Artery Relations Medially to? basilic vien, ulnar and mdian nerves. 9- The Ulnar Artery Begins in the cubital fossa at the level of? neck of radius.